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A CASE OF MELANOTIC SARCOMA OF THE LIVER, SECONDARY TO A MELANOTIC SARCOMA OF THE EYE REMOVED BY OPERATION TEN YEARS PREVIOUSLY.
363 the stomach. It is excited by irritation of the glosso-vagusaccessory nuclei which are closely related in the medulla with the nucleus of the fifth cranial nerve, the branches of which innervate the muscles of the lower jaw. The remarkable result obtained from the passage of the oesophageal tube should have the effect of bringing to the notice of the profession the importance of gastric symptoms in cases of this type, since many cases commonly regarded as illustrations of impairment of the contractile function of the myocardium, among which angina pectoris is usually numbered, are in reality subjects of a gastric reflex. Streatham-hill, S.W.
NOTES ON A RARE CASE OF CONGENITAL HÆMATOMA. BY SPENCER SHEILL, F.R.C.P. IREL., &C., EXAMINER IN MIDWIFERY AND GYNÆCOLOGY TO CONJOINT BOARD OF R.C.P. AND R.C.S. IRELAND.
THE subject was a male child, born early in February of this year, which, on examination immediately after birth, was found to have a soft tumour under one of its armpits. .The labour was natural in every detail, although it is true the mother was unusually active in struggling during chloroform administration. The tumour was of about the size of a A CASE OF MELANOTIC SARCOMA OF THE LIVER, hen’s egg and plainly cystic in character. It was situated in the mid-axillary line about an inch below the axilla. It SECONDARY TO A MELANOTIC SARCOMA OF appeared at first to be affected by respiration, but closer THE EYE REMOVED BY OPERATION inspection revealed that this -I hardening " of the mass was TEN YEARS PREVIOUSLY. most likely due to the action of surrounding muscles. As well as could be made out, the ribs beneath the tumour BY CHARLES H. LILLEY, M.B., CH. B. ST. AND., It appeared to cause the little patient no were normal. HOUSE SURGEON, ROYAL DEVON AND EXETER HOSPITAL. inconvenience other than inability to adduct the humerus THE patient, a female, aged 46 years, was admitted into to the normal extent, although the child was unduly the Royal Devon and Exeter Hospital on Nov. 10th, 1910. cress, but that is perhaps too common a complaint to be of Since the beginning of May, 1910, she had noticed that, to value as a symptom. On waiting eight days, as the tumour seemed to be if anything slightly larger, I decided to tap it, use her own expression, she was getting hard in the stomach." She placed little or no importance upon this and withdrew through a large needle nearly four fluid ounces condition until a month prior to admission, when she began of what appeared to be almost pure blood of a very dark hue. to suffer severe pain in the back and down the legs, which The tumour collapsed completely and the ribs beneath were Later she noticed that she was palpated as normal. It again began to fill slowly and by ten at times were swollen. getting much stouter, and that her clothes were very tight days had attained its previous size. Two days later I noticed a "pulsating" lump at the side of the neck above the around the waist. The previous history of the case had a most important clavicle, but the "pulsation " proved to be a "fluid wave " bearing upon the diagnosis. In the year 1900 the patient had communicated from the original tumour by arm movements and by respiration ; one could easily imitate this by the fingers a tumour of the eye removed at the West of England Eye on the tumours above and below the clavicle. All this Mr. C. A. and on I found placed Exeter, Infirmary, by Roper, inquiry time there were no palpable glands in the neck or axilla. that this tumour was a melanotic sarcoma. On admission the patient’s general condition was remark- The mother had cardiac disease, as had also her father and ably good ; she was well nourished and not at all cachectic two sisters, but I cannot see in this fact anything to throw in appearance. Her right eye had been enucleated, and the light upon the origin of the tumour. Of course, I feared socket appeared to be quite healthy. An examination of the sarcoma and was obliged to give a guarded opinion to the abdomen showed the presence of a very large and hardI parents. On March 4th, that is, about four weeks after the tumour filling the greater part of the abdominal cavity. Its birth of the child, I noted in my case-book : " Tumour softer upper limit was represented by a line drawn horizontally and smaller, and bulging above clavicle absent." On across the chest at the level of the fifth rib. Laterally the March 21st the tumour had entirely disappeared, but what tumour filled both flanks. It was just possible to get the feel like two slightly enlarged glands occupy its site. I cannot lock upon this case as comparable to a sternoedge of one’s hand between the tumour’s lower limit and the hsematoma due to violence at birth, and my pubic arch, and at the middle of the lower border a distinct mastoid or other The surface of the tumour was inability to find records of anything similar in a fairly full notch could be felt. nodular in places. The baemopoietic and other systems were search through the literature has prompted me to publish normal. The urine did not darken very much on standing, these few notes. Dublin. but on the addition of a few drops of ferric chloride it at The patient went once darkened, a black deposit forming. steadily downhill. The abdomen got progressively larger, increasing in circumference from 34t to 40 inches. The application of the X rays had no effect in reducing the size of the growth. Later jaundice became a very marked feature and the patient passed into a drowsy, stuporous condition, The Su.rgery (If the Diseases of the Appendix Verniiformis and and eventually died on Dec. 27th-i.e., six weeks after their Com’Plioations. By WILLIAM HENRY BATTLE, admission to hospital. The temperature throughout had F. R. C. S. Eng., Surgeon and Joint Lecturer on Surgery to shown an evening rise, being frequently over 101° F. and St. Thomas’s Hospital; and EDRED M. CORNER, M. A., dropping to normal in the morning. M.B., M. C. Cantab , F. R. C. S. Eng., Surgeon in Charge of At the post-mortem examination the liver was found to be Out-patients and the Surgical Isolation Wards to St. enormously enlarged and it weighed 19 lb. 6 oz. in fresh Thomas’s Hospital ; Lecturer on Practical Surgery. condition. It was very dark in colour. On cutting into the Second and enlarged edition. London : Constable and tissue it was found to vary in colour, being coal-black at Co., Limited. 1910. Pp. 291. Price 10s. 6d. net. some places and at others of a greyish-black colour. The SEVEN have elapsed since the appearance of the first growth was diffuse, and only one or two islands of normal edition ofyears this work ; in those seven years much has been liver tissue were to be seen. The difference in colour was doubtless due to the greater accumulation of pigment at written about the diseases of the appendix, and the authors The other organs were normal, have endeavoured to incorporate in the volume the important some places than at others. A microscopical section the liver alone being involved. of the new material. The effect has been a very showed spindle cells with blackish-brown granules deposited points natural increase in the size of the volume. in and around them. The book commences with a brief history of our knowledge I have thought this case of sufficient interest to warrant its of the affection, and it is pointed out that as long ago as 1711 as the being published illustrating (1) long period-viz., 10 years-which had intervened between the removal of the Heister recognised the relationship between disease of the primary growth and the secondary invasion of the liver ; and appendix and diffuse peritonitis. The anatomy of the region (2) the large size to which these secondary growths in the of the appendix is carefully described, and the varieties of liver may attain. I have to thank Mr. Roper, in whose ward the patient wa°, form and position of the organ are illustrated by diagrams. The authors give good reason for thinking that the appendix for permission to publish these brief notes. Exeter. is not functionless, but that it is a specialised part of the
I
Reviews and Notices of Books.
I
NOTES ON A RARE CASE OF CONGENITAL HÆMATOMA. BY SPENCER SHEILL, F.R.C.P. IREL., &C., EXAMINER IN MIDWIFERY AND GYNÆCOLOGY TO CONJOINT BOARD OF R.C.P. AND R.C.S. IRELAND.
THE subject was a male child, born early in February of this year, which, on examination immediately after birth, was found to have a soft tumour under one of its armpits. .The labour was natural in every detail, although it is true the mother was unusually active in struggling during chloroform administration. The tumour was of about the size of a A CASE OF MELANOTIC SARCOMA OF THE LIVER, hen’s egg and plainly cystic in character. It was situated in the mid-axillary line about an inch below the axilla. It SECONDARY TO A MELANOTIC SARCOMA OF appeared at first to be affected by respiration, but closer THE EYE REMOVED BY OPERATION inspection revealed that this -I hardening " of the mass was TEN YEARS PREVIOUSLY. most likely due to the action of surrounding muscles. As well as could be made out, the ribs beneath the tumour BY CHARLES H. LILLEY, M.B., CH. B. ST. AND., It appeared to cause the little patient no were normal. HOUSE SURGEON, ROYAL DEVON AND EXETER HOSPITAL. inconvenience other than inability to adduct the humerus THE patient, a female, aged 46 years, was admitted into to the normal extent, although the child was unduly the Royal Devon and Exeter Hospital on Nov. 10th, 1910. cress, but that is perhaps too common a complaint to be of Since the beginning of May, 1910, she had noticed that, to value as a symptom. On waiting eight days, as the tumour seemed to be if anything slightly larger, I decided to tap it, use her own expression, she was getting hard in the stomach." She placed little or no importance upon this and withdrew through a large needle nearly four fluid ounces condition until a month prior to admission, when she began of what appeared to be almost pure blood of a very dark hue. to suffer severe pain in the back and down the legs, which The tumour collapsed completely and the ribs beneath were Later she noticed that she was palpated as normal. It again began to fill slowly and by ten at times were swollen. getting much stouter, and that her clothes were very tight days had attained its previous size. Two days later I noticed a "pulsating" lump at the side of the neck above the around the waist. The previous history of the case had a most important clavicle, but the "pulsation " proved to be a "fluid wave " bearing upon the diagnosis. In the year 1900 the patient had communicated from the original tumour by arm movements and by respiration ; one could easily imitate this by the fingers a tumour of the eye removed at the West of England Eye on the tumours above and below the clavicle. All this Mr. C. A. and on I found placed Exeter, Infirmary, by Roper, inquiry time there were no palpable glands in the neck or axilla. that this tumour was a melanotic sarcoma. On admission the patient’s general condition was remark- The mother had cardiac disease, as had also her father and ably good ; she was well nourished and not at all cachectic two sisters, but I cannot see in this fact anything to throw in appearance. Her right eye had been enucleated, and the light upon the origin of the tumour. Of course, I feared socket appeared to be quite healthy. An examination of the sarcoma and was obliged to give a guarded opinion to the abdomen showed the presence of a very large and hardI parents. On March 4th, that is, about four weeks after the tumour filling the greater part of the abdominal cavity. Its birth of the child, I noted in my case-book : " Tumour softer upper limit was represented by a line drawn horizontally and smaller, and bulging above clavicle absent." On across the chest at the level of the fifth rib. Laterally the March 21st the tumour had entirely disappeared, but what tumour filled both flanks. It was just possible to get the feel like two slightly enlarged glands occupy its site. I cannot lock upon this case as comparable to a sternoedge of one’s hand between the tumour’s lower limit and the hsematoma due to violence at birth, and my pubic arch, and at the middle of the lower border a distinct mastoid or other The surface of the tumour was inability to find records of anything similar in a fairly full notch could be felt. nodular in places. The baemopoietic and other systems were search through the literature has prompted me to publish normal. The urine did not darken very much on standing, these few notes. Dublin. but on the addition of a few drops of ferric chloride it at The patient went once darkened, a black deposit forming. steadily downhill. The abdomen got progressively larger, increasing in circumference from 34t to 40 inches. The application of the X rays had no effect in reducing the size of the growth. Later jaundice became a very marked feature and the patient passed into a drowsy, stuporous condition, The Su.rgery (If the Diseases of the Appendix Verniiformis and and eventually died on Dec. 27th-i.e., six weeks after their Com’Plioations. By WILLIAM HENRY BATTLE, admission to hospital. The temperature throughout had F. R. C. S. Eng., Surgeon and Joint Lecturer on Surgery to shown an evening rise, being frequently over 101° F. and St. Thomas’s Hospital; and EDRED M. CORNER, M. A., dropping to normal in the morning. M.B., M. C. Cantab , F. R. C. S. Eng., Surgeon in Charge of At the post-mortem examination the liver was found to be Out-patients and the Surgical Isolation Wards to St. enormously enlarged and it weighed 19 lb. 6 oz. in fresh Thomas’s Hospital ; Lecturer on Practical Surgery. condition. It was very dark in colour. On cutting into the Second and enlarged edition. London : Constable and tissue it was found to vary in colour, being coal-black at Co., Limited. 1910. Pp. 291. Price 10s. 6d. net. some places and at others of a greyish-black colour. The SEVEN have elapsed since the appearance of the first growth was diffuse, and only one or two islands of normal edition ofyears this work ; in those seven years much has been liver tissue were to be seen. The difference in colour was doubtless due to the greater accumulation of pigment at written about the diseases of the appendix, and the authors The other organs were normal, have endeavoured to incorporate in the volume the important some places than at others. A microscopical section the liver alone being involved. of the new material. The effect has been a very showed spindle cells with blackish-brown granules deposited points natural increase in the size of the volume. in and around them. The book commences with a brief history of our knowledge I have thought this case of sufficient interest to warrant its of the affection, and it is pointed out that as long ago as 1711 as the being published illustrating (1) long period-viz., 10 years-which had intervened between the removal of the Heister recognised the relationship between disease of the primary growth and the secondary invasion of the liver ; and appendix and diffuse peritonitis. The anatomy of the region (2) the large size to which these secondary growths in the of the appendix is carefully described, and the varieties of liver may attain. I have to thank Mr. Roper, in whose ward the patient wa°, form and position of the organ are illustrated by diagrams. The authors give good reason for thinking that the appendix for permission to publish these brief notes. Exeter. is not functionless, but that it is a specialised part of the
I
Reviews and Notices of Books.
I